The Internet Book of Critical Care Podcast IBCC Episode 7 - Cardiogenic Shock & Severe LV Dysfunction
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Oct 17, 2018 Explore the assessment and management of cardiogenic shock and severe LV dysfunction, including the use of norepinephrine and epinephrine, the benefits of Jockson, and important considerations in cardiac failure management.
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Assess Perfusion and Wedge Pressure
- Assess cardiac index by clinical signs like extremity temperature, urine output, and mental status.
- Use lung ultrasound to approximate pulmonary capillary wedge pressure noninvasively and quickly.
Forster Classification in Shock
- Forster classification pairs cardiac output and wedge pressure to categorize patients into warm/dry, warm/wet, cold/dry, cold/wet.
- Cold and wet patients are critically ill and require aggressive ICU interventions beyond fluids or diuresis.
Manage Blood Pressure Thoughtfully
- Use afterload reduction in hypertensive heart failure patients with nitroglycerin or hydroxyine and isosorbide dinitrate.
- In severe hypotension, consider norepinephrine or a low dose epinephrine to improve blood pressure and perfusion.